Smoking among pregnant women, particularly public health maternity patients, is one of the most important risk factors in predicting infant and maternal morbidity and mortality. Smoking among pregnant women has been a national priority for our 1990 and Year 2000 health objectives. The objective of the proposed study-- Smoking Cessation and Reduction In Pregnancy Trial (SCRIPT) -- is to evaluate the EFFECTIVENESS of a smoking cessation intervention for pregnant smokers delivered as part of routine care by public health nurses in Alabama. Four aims will be completed: 1) To randomly select a representative sample of public health maternity clinics and Medicaid-supported obstetrical care patients in Alabama; 2) To conduct, among patients and staff at Aim #1 sites, a three-phase formative evaluation of a multi-component smoking cessation and reduction intervention, including a patient education, counseling, skills training program for nursing staff; 3) To evaluate the behavioral impact of the multi-component health education intervention program among at least 2000 pregnant smokers, 1000+ randomly assigned to an Experimental (E) Group and 1000+ randomly assigned to a Control (C) Group at their first prenatal visit; and, 4) To conduct a process evaluation to document the degree of patient exposure to the intervention methods and evaluation procedures specified in Aim #3. SCRIPT will confirm the EFFECTIVENESS RATES AND EXTERNAL VALIDITY of the intervention. Very limited insight is available in the Public Health Practice literature about these two outcomes.